title: Increased glucagon-like peptide-1 secretion and postprandial hypoglycemia in children after Nissen fundoplication.
abstract: BACKGROUND
  Postprandial hypoglycemia (PPH) is a frequent complication of Nissen fundoplication in children. The mechanism responsible for the PPH is poorly understood, but involves an exaggerated insulin response to a meal and subsequent hypoglycemia. We hypothesize that increased glucagon-like peptide-1 (GLP-1) secretion contributes to the exaggerated insulin surge and plays a role in the pathophysiology of this disorder.
  
  
  OBJECTIVE
  The aim of the study was to characterize glucose, insulin, and GLP-1 response to an oral glucose load in children with symptoms of PPH after Nissen fundoplication.
  
  
  METHODS
  Ten patients with suspected PPH and a history of Nissen fundoplication and eight control subjects underwent a standard oral glucose tolerance test at The Children's Hospital of Philadelphia. Blood glucose (BG), insulin, and intact GLP-1 levels were obtained at various time points.
  
  
  METHODS
  Children ages 4 months to 13 years old were studied.
  
  
  METHODS
  Change scores for glucose, insulin, and intact GLP-1 were recorded after an oral glucose tolerance test.
  
  
  RESULTS
  All cases had hypoglycemia after the glucose load. Mean BG at nadir (+/- sd) was 46.7 +/- 11 mg/dl for cases (vs. 85.9 +/- 21.3 mg/dl; P < 0.0005). Mean change in BG from baseline to peak (+/- sd) was 179.3 +/- 87.4 mg/dl for cases (vs. 57.8 +/- 39.5 mg/dl; P = 0.003). Mean change in BG (+/- sd) from peak to nadir was 214.4 +/- 85.9 mg/dl for cases (vs. 55.9 +/- 41.1 mg/dl, P < 0.0005). Mean change in insulin (+/- sd) from baseline to peak was 224.3 +/- 313.7 microIU/ml for cases (vs. 35.5 +/- 22.2 microIU/ml; P = 0.012). Mean change in GLP-1 (+/- sd) from baseline to peak was 31.2 +/- 24 pm (vs. 6.2 +/- 9.5 pm; P = 0.014).
  
  
  CONCLUSIONS
  Children with PPH after Nissen fundoplication have abnormally exaggerated secretion of GLP-1, which may contribute to the exaggerated insulin surge and resultant hypoglycemia.
authors.affiliation: The Children's Hospital of Philadelphia, Abramson Research Center, Room 802A, 3615 Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Palladino
authors.forename: Samir
authors.initials: S
authors.lastname: Sayed
authors.forename: Lorraine E
authors.initials: LE
authors.lastname: Levitt Katz
authors.forename: Paul R
authors.initials: PR
authors.lastname: Gallagher
authors.forename: Diva D
authors.initials: DD
authors.lastname: De León
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication / Q000009:adverse effects*; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism*; D005951:Glucose Tolerance Test; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007223:Infant; D007328:Insulin / Q000097:blood; D008297:Male
chemical_list: D001786:Blood Glucose; D007328:Insulin; D052216:Glucagon-Like Peptide 1